1. The Pulse of Madison County: HEALTHCARE FORUM 2011 May 4, 2011 Mary Currier, MD, MPH Mississippi State Department of Health

2. Outline County rankings County and state statistics Prevention: – Benefits – Target behaviors

3. University of Wisconsin Population Health Institute. County Health Rankings 2011. Accessible at www.countyhealth rankings.org. www.countyhealth rankings.org

4. County Health Rankings Mississippi

6. County Health Rankings Madison County, Mississippi Madison County Error Margin National Benchmark* Mississippi Rank (of 81) Health Outcomes7 Mortality 27 Premature death10,78610,054-11,5185,56411,030 Morbidity 2 Poor or fair health16%14-18%10%22% 1 (tied) Poor physical health days2.92.4-3.32.64.1 2 Poor mental health days2.82.3-3.22.34.2 2 Low birthweight10.8%10.1-11.4%6.0%11.6% 26 (tied with two others)

7. County Health Rankings Madison County, Mississippi Madison County Error Margin National Benchmark* Mississippi Rank (of 81) Health Factors1 Health Behaviors1 Adult smoking16%13-19%15%24% 2 (tied) Adult obesity30%26-34%25%34% 2 Excessive drinking12%9-14%8%11% 48 (tied with seven others) Motor vehicle crash death rate 2016-2412322 (tied ) Sexually transmitted infections 583 83728 29 Teen birth rate4340-462265 5

8. County Health Rankings Madison County, Mississippi Madison County Error Margin National Benchmark* Mississippi Rank (of 81) Health Factors1 Clinical Care1 Uninsured adults 21%18-25%13%24% 13 (tied with nine others) Primary care providers 446:1 631:11,155:1 2 Preventable hospital stays 6864-7352100 5 (tied with two others) Diabetic screening 82%71-92%89%78% 22 (tied with six others) Mammography screening 67%57-77%74%56% 3

9. Madison County Error Margin National Benchmark* Mississippi Rank (of 81) Health Factors 1 Social & Economic Factors4 High school graduation 70% 92%64% 5 (tied with nine others Some college71% 68%53% 2 Unemployment6.9%6.7-7.1%5.3%9.6% 3 Children in poverty 18%14-22%11%30% 3 Inadequate social support 16%13-19%14%25% 2 (tied) Single-parent households 31% 20%44% 5 (tied with two others) Homicide rate118-14110 50 (tied with six others) County Health Rankings Madison County, Mississippi

10. Madison County Error Margin National Benchmark* Mississippi Rank (of 81) Health Factors1 Physical Environment2 Air pollution- particulate matter days 0 01 1 Air pollution- ozone days 2 03 71 (tied) Access to healthy foods 80% 92%58% 18 (tied) Access to recreational facilities 16 177 2 County Health Rankings Madison County, Mississippi

11. Physical Inactivity US, 2008* *BRFSS data

12. Physical Inactivity* Madison Co. 26.0% Mississippi 32.3% US 23.8% *A person is considered physically inactive if during the past month, other than a regular job, he or she did not participate in any physical activities or exercises such as running, calisthenics, golf, gardening, or walking for exercise.

13. Obesity US by County, 2008* * BRFSS data

14. Obesity, Mississippi by County 2008* Madison Co. 29.9% Mississippi 35.4% US 27.2% *BRFSS data

15. Diabetes, US by County, 2008* *BRFSS data

16. Diabetes, Mississippi by County, 2008* Madison Co. 10.6% Mississippi 11.6% US 8.3% *BRFSS data

18. Health Consequences of Obesity Coronary heart disease Type 2 diabetes Cancers (endometrial, breast, and colon) Hypertension (high blood pressure) Dyslipidemia (for example, high total cholesterol or high levels of triglycerides) Stroke Liver and Gallbladder disease Sleep apnea and respiratory problems Osteoarthritis (a degeneration of cartilage and its underlying bone within a joint) Gynecological problems (abnormal menses, infertility)

19. Why Should Employers Care? The Cost of Obesity is High: In 2008, the annual healthcare cost of obesity in the US was estimated to be as high as 147 billion dollars a year, double the amount a decade ago (28). Annual medical expenses for the obese are estimated to be 42 percent higher than for a person of a healthy weight (28).  Workplace obesity prevention programs may be an effective way for employers, including local governments, to reduce obesity, lower health care costs, lower absenteeism, and increase employee productivity.

20. Settings for the Prevention and Treatment of Obesity Medical Settings Home School Work Site Community

21. Why Should Employers Get Involved? Potential benefits to employers: Reduces cost for chronic diseases Decreases absenteeism Reduces employee turnover Improves worker satisfaction Demonstrates concern for your employees Improves morale

22. Why Should Employers Get Involved? Potential benefits to your employees: Ensures greater productivity Reduces absenteeism Improves fitness and health Provides social opportunity and source of support within the workplace

23. Target Behaviors for Change CDC focuses on six target behaviors for the prevention of obesity and other chronic diseases 1.Increase physical activity 2.Increase consumption of fruits and vegetables 3.Increase breastfeeding initiation, duration, and exclusivity 4.Decrease consumption of sugar sweetened beverages 5.Decrease consumption of high energy dense, nutrient poor, foods 6.Decrease television viewing (screen time)

24. Employer Health Strategies* Health Impact Insurance Health Fairs & Assessments Disease Management Workplace Health Policies Community Health & Wellness *Paul Jarris, MD, Director of ASTHO

25. Policies and Environmental Strategies Vending machines and cafeteria – healthy options – fewer unhealthy options Point of decision prompts – reminders at the elevators to take the stairs Time allowed for walking – and a convenient place to do so Make the healthy choice the easy choice

26. “….it’s not about looking at healthcare as a cost for someone else to manage, but rather health as an investment that they need to leverage.” “…the health of nations will impact the wealth of nations. In fact, good health is good business.” Loeppke, R. (2008), “The value of health and the power of prevention”, International Journal of Workplace Health Management, vol. 1. No. 2, pp. 95-108.

27. Resources for Implementing Strategies and Measures and Monitoring Performance CDC’s Recommended Community Strategies and Measurements to Prevent Obesity in the United States, July, 2009 http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5807a1.htm http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5807a1.htm A detailed Implementation and Measurement Guide to assist local governments, states, and policy makers in implementing the CDC recommended strategies and reporting on the associated measurements: http://www.cdc.gov/obesity/downloads/community_strategies_g uide.pdf http://www.cdc.gov/obesity/downloads/community_strategies_g uide.pdf CDC’s obesity cost calculator http://www.cdc.gov/leanworks/costcalculator/index.html http://www.cdc.gov/leanworks/costcalculator/index.html Measures incorporated into ICMA’s Center for Performance Measurement system: http://www.icma.org/performancehttp://www.icma.org/performance

28. Other Resources for Prevention http://thomsonreuters.com/content/healthcare/pdf/w hite_papers/Obesity_in_Workforce_Brief Obesity in Workforce http://www.countyhealthrankings.org/take- action/employers-and-businesses Recommendations for cost effective prevention http://www.cdc.gov/nccdphp/dnpao/hwi/index.htm http://www.cdc.gov/nccdphp/dnpao/hwi/index.htm CDC Healthier Worksite Initiative http://www.cdc.gov/WinnableBattles/Obesity/http://www.cdc.gov/WinnableBattles/Obesity/ CDC Nutrition, physical activity and obesity website